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This article discusses the use of trans-spinal magnetic stimulation (TsMS) as a potential treatment for freezing of gait (FoG) induced by deep brain stimulation (DBS) in a patient with generalized dystonia. DBS is an effective treatment for dystonia, but it can sometimes cause FoG, which reduces its benefits. TsMS is a noninvasive alternative that has shown promise in relieving FoG in Parkinson's disease. In this study, a patient with DBS-induced FoG underwent TsMS, and improvements were observed in FoG scores and gait performance. Although this study only included one patient, it suggests that TsMS may be a useful strategy for dystonic patients with secondary parkinsonism or FoG. [Extracted from the article]

Objective: To investigate the association between left epileptiform activity and language laterality indices (LI) in patients with right mesial temporal sclerosis (MTS). Methods: Twenty‐two patients with right MTS and 22 healthy subjects underwent fMRI scanning while performing a language task. LI was calculated in multiple regions of interest (ROI). Data on the presence of left epileptiform abnormalities were obtained during prolonged video‐EEG monitoring. Results: After correction for multiple comparisons, LI was reduced in the middle temporal gyrus in the left interictal epileptiform discharges (IED+) group, compared with the left IED− group (p < 0.05). Significance: Using a responsive reading naming fMRI paradigm, right MTS patients who presented left temporal interictal epileptiform abnormalities on video‐EEG showed decreased LI in the middle temporal gyrus, indicating decreased left middle temporal gyrus activation, increased right middle temporal gyrus activation or a combination of both, demonstrative of language network reorganization, specially in the MTG, in this patient population. Plain Language Summary: This research studied 22 patients with right mesial temporal sclerosis (a specific type of epilepsy) comparing them to 22 healthy individuals. Participants were asked to perform a language task while undergoing a special brain imaging technique (fMRI). The findings showed that patients with epilepsy displayed a change in the area of the brain typically responsible for language processing. This suggests that their brains may have adapted due to their condition, altering the way language is processed. [ABSTRACT FROM AUTHOR]

Background: Dystonia is associated with disabling nonmotor symptoms like chronic pain (CP), which is prevalent in dystonia and significantly impacts the quality of life (QoL). There is no validated tool for assessing CP in dystonia, which substantially hampers pain management. Objective: The aim was to develop a CP classification and scoring system for dystonia. Methods: A multidisciplinary group was established to develop the Dystonia‐Pain Classification System (Dystonia‐PCS). The classification of CP as related or unrelated to dystonia was followed by the assessment of pain severity score, encompassing pain intensity, frequency, and impact on daily living. Then, consecutive patients with inherited/idiopathic dystonia of different spatial distribution were recruited in a cross‐sectional multicenter validation study. Dystonia‐PCS was compared to validated pain, mood, QoL, and dystonia scales (Brief Pain Inventory, Douleur Neuropathique‐4 questionnaire, European QoL‐5 Dimensions‐3 Level Version, and Burke–Fahn–Marsden Dystonia Rating Scale). Results: CP was present in 81 of 123 recruited patients, being directly related to dystonia in 82.7%, aggravated by dystonia in 8.8%, and nonrelated to dystonia in 7.5%. Dystonia‐PCS had excellent intra‐rater (Intraclass Correlation Coefficient ‐ ICC: 0.941) and inter‐rater (ICC: 0.867) reliability. In addition, pain severity score correlated with European QoL‐5 Dimensions‐3 Level Version's pain subscore (r = 0.635, P < 0.001) and the Brief Pain Inventory's severity and interference scores (r = 0.553, P < 0.001 and r = 0.609, P < 0.001, respectively). Conclusions: Dystonia‐PCS is a reliable tool to categorize and quantify CP impact in dystonia and will help improve clinical trial design and management of CP in patients affected by this disorder. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]

Background: Unlike motor symptoms, the effects of deep brain stimulation (DBS) on non‐motor symptoms associated with dystonia remain unknown. Methods: The objective of this study was to assess the effects of DBS on evoked experimental pain and cutaneous sensory thresholds in a crossover, double‐blind on/off study and compare these results with those of healthy volunteers (HV). Results: Sixteen patients with idiopathic dystonia (39.9 ± 13 years old, n = 14 generalized) with DBS of the globus pallidus internus underwent a battery of quantitative sensory testing and assessment using a pain top‐down modulation system (conditioned pain modulation, CPM). Results for the more and less dystonic body regions were compared in on and off stimulation. The patients' results were compared to age‐ and sex‐matched HV. Descending pain modulation CPM responses in dystonic patients (on‐DBS, 11.8 ± 40.7; off‐DBS, 1.8 ± 22.1) was abnormally low (defective) compared to HV (−15.6 ± 23.5, respectively p =.006 and p =.042). Cold pain threshold and cold hyperalgesia were 54.8% and 95.7% higher in dystonic patients compared to HV. On‐DBS CPM correlated with higher Burke‐Fahn‐Marsden disability score (r = 0.598; p =.014). While sensory and pain thresholds were not affected by DBS on/off condition, pain modulation was abnormal in dystonic patients and tended to be aggravated by DBS. Conclusion: The analgesic effects after DBS do not seem to depend on short‐duration changes in cutaneous sensory thresholds in dystonic patients and may be related to changes in the central processing of nociceptive inputs. [ABSTRACT FROM AUTHOR]

Background: The different phenotypic presentations of fibromyalgia (FM) have been infrequently studied and may have diagnostic and therapeutic implications. The aim of this study was to explore differences between FM patients with classical symmetric (s-FM) presentation and FM patients with marked asymmetric (a-FM) pain.Methods: We performed two consecutive cross-sectional studies on FM patients and matched healthy volunteers (HV). FM patients were divided into a-FM (and s-FM groups according to their score of pain intensity on each body side; patients with a difference of ≥40 mm in VAS between left and right sides were classified as a-FM, otherwise classified as s-FM. Participants (FM = 32; HV = 31) were assessed for clinical, cortical excitability (CE), quantitative sensory testing (QST; study 1), and intraepidermal nerve fibre density (IENFD) determinations (study 2).Results: While pain intensity did not significantly differ between s-FM and a-FM patients, pain interference in daily activities was significantly higher in the a-FM as compared to the s-FM group (54.7 ± 8.9 and 37.6 ± 13.5; p < .0001). PPT was significantly lower in the more painful side of a-FM as compared to the HV (27.7 ± 7.9 and 49.9 ± 13.0; p < .0001), while PPT in the less painful side of a-FM was significantly higher than PPT values in the s-FM (35.8 ± 8.3 and 27.7 ± 5.5; p = .031). S-FM and a-FM had significantly abnormal intracortical inhibition values on CE measurements compared to HV. There were no significant differences in IENFD between groups.Conclusions: Within the current FM criteria, there exist different phenotypes with clinical, psychophysics, and neurophysiological findings that are not related to peripheral IENFD abnormalities.Significance: Current fibromyalgia criteria may contain different phenotypes of fibromyalgia based on the lateralization of pain. [ABSTRACT FROM AUTHOR]

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